The Graded Prognostic Assessment (gpa): Diagnosis-specific Prognostic Indices And Treatment Outcomes For Patients With Newly Diagnosed Brain MetastasesPaul Sperduto1, Samuel T. Chao2, Penny K. Sneed3, Xianghua Luo1, David Roberge4, Amit Bhatt5, Paul D. Brown6, Helen Shih7, John Kirkpatrick8, Laurie E. Gaspar91University of Minnesota 2USA Cleveland Clinic 3University of California San Francisco 4McGill University Health Center 5University of Wisconsin 6Mayo Clinic 7Massachusetts General Hospital 8Duke University Medical Center 9University of Colorado Health Science Center Keywords: gamma knife, grading system, brain metastasis, outcome, radiosurgeryInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?Controversy endures regarding optimal management of patients with brain metastases (BM). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. What is the purpose of your study?The purpose of this study is to identify significant diagnosis-specific prognostic factors (PF) and indices (Diagnosis-Specific Graded Prognostic Assessment, DS-GPA). Describe your patient group.A retrospective database of 5067 patients treated for BM between 1985-2007 was generated from 11 institutions. Describe what you did.After exclusion of patients with recurrent BMs or incomplete data, 4259 patients with newly-diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of PF and outcomes by primary site and treatment were performed. The significant PF were determined and used to define DS-GPA prognostic indices. The DS-GPA scores were calculated and correlated with outcome by diagnosis and treatment. Describe your main findings.The significant PF vary by diagnosis. For NSCLC and SCLC, the significant PF were KPS, age, extracranial metastases (ECM) and #BM, confirming the original GPA for these diagnoses. For melanoma and renal cell, the significant PF were KPS and #BM. For breast and GI, the only significant PF was KPS. Two new DS-GPA indices were thus designed for breast/GI and melanoma/renal cell. Median survival by GPA score, diagnosis and treatment is presented. Describe the main limitation of this study.This is a retrospective study. Describe your main conclusion.PF for BM patients vary by diagnosis. The original GPA was confirmed for NSCLC and SCLC. New DS-GPA indices were determined for other histologies, correlated with outcome, and statistical separation between groups was confirmed. Describe the importance of your findings and how they can be used by others.These data should be considered in the design of future randomized trials and in clinical decision-making. Controversy endures regarding optimal management of patients with brain metastases (BM). Debate persists, despite many randomized trials, perhaps because BM patients are a heterogeneous population. The purpose of this study is to identify significant diagnosis-specific prognostic factors (PF) and indices (Diagnosis-Specific Graded Prognostic Assessment, DS-GPA). A retrospective database of 5067 patients treated for BM between 1985-2007 was generated from 11 institutions. After exclusion of patients with recurrent BMs or incomplete data, 4259 patients with newly-diagnosed BMs remained eligible for analysis. Univariate and multivariate analyses of PF and outcomes by primary site and treatment were performed. The significant PF were determined and used to define DS-GPA prognostic indices. The DS-GPA scores were calculated and correlated with outcome by diagnosis and treatment. The significant PF vary by diagnosis. For NSCLC and SCLC, the significant PF were KPS, age, extracranial metastases (ECM) and #BM, confirming the original GPA for these diagnoses. For melanoma and renal cell, the significant PF were KPS and #BM. For breast and GI, the only significant PF was KPS. Two new DS-GPA indices were thus designed for breast/GI and melanoma/renal cell. Median survival by GPA score, diagnosis and treatment is presented. This is a retrospective study. PF for BM patients vary by diagnosis. The original GPA was confirmed for NSCLC and SCLC. New DS-GPA indices were determined for other histologies, correlated with outcome, and statistical separation between groups was confirmed. These data should be considered in the design of future randomized trials and in clinical decision-making. Project Roles:
P. Sperduto (), S. Chao (), P. Sneed (), X. Luo (), D. Roberge (), A. Bhatt (), P. Brown (), H. Shih (), J. Kirkpatrick (), L. Gaspar ()
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